HomeMy WebLinkAboutMiscellaneous - 5 KIERAN ROAD 4/30/2018 I 5 KIERAN ROAD
J 21&098A�0044.0000.0
SEPTIC SYSTEM INSPECTION FORM
ADDRESS K 1 P-��GL✓�
DATE INSPECTED j
PROPERLY FUNCTIONING? N
WEATHER CONDITIONS
COMMENTS :
WATER QUALITY TES T Eb . }ZESULTS?
DYE TEST PERFORMED? Y N
DATE?
SKETCH:
WATERSHED RESIDENTS QUESTIONNAIRE
1. Name /� ' 's . lge—eI P, IJ
2. Street Address S"- h504 4 2 9 rj 2 d f7
3. How many members are in your household?
4. What type of sewage disposal system do you have?
❑ cesspool
® septic tank and leaching area
❑ connection to municipal sewer
❑ other (describe)
❑ do not know
5. Are the plans (drawings) for your sewage disposal system on file with the Board of Health?
®, yes ❑ no ❑ . do not know
6. How old is your sewage disposal system? ❑ 0-5 years ❑ 6-10 years [!� 11-20 years
❑ over 20 years ❑ do not know
7. Has your sewage disposal system been rebuilt or repaired?
U yes ❑ no ❑ do not know
_ If yes, approximately how long ago? 16 years. What was done?
8. How frequently is your sewage disposal system pumped out? ❑ annually
❑ every 2-4 years every 5-10 years ❑ over 10 years ❑ never
9. Have you had any problems with your sewage disposal system? ❑ yes �1 no
If yes, what problems?
❑ repeated pump-outs needed
❑ system clogs, backs up, or drains slowly
❑ odors
❑ sewage surfaces through ground
10. How many of each appliance are connected to your sewage disposal system?
washing machine K die�hwaq-�er k garbage disposal
{ dehumidifier drain sump pump toilet _
roof/pavement drains sh6ver%"Dathtub K
11. Please state the brand and type (liquid or powder) of detergent you use for:
dishwasher 1{En/mo2E"
clotheswasher �'E
12. Does your property have a lawn? ] yes ❑ no
If yes, approximately what size?
❑ less than 1/4 acre M 1/4 acre ❑ % acre ❑ 3/4 acre ❑ 1 acre
❑ more than 1 acre (Specify) acres
13. How often do you fertilize your lawn?
No. of applications per year
Season(s) of the year EA2Ly S�r4+�L'2 — Lgrr" SaJMMe"1L— 1�� L t-
•
14. Please state the brand and type(liquid or granular) of lawn fertilizer you use:
"Woo 1- F_4�tCr1F_rAt.AM1n�
L� Check here if your lawn is maintained by'a professional landscape contractor.
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4187
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! Date.....1........ ...
f NOR7M 1
'+ .°..° ao� TOWN OF NORTH ANDOVER
p PERMIT FOR WIRING
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This certifies that /���"
has permission to perform .........!.l v.:. !�' ����i<`e
..... .. .......................................................
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wiring in the building of........ ................... ...... ............................................
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at.... ....... (
........... ..... ...... ... ....................... . ,North Ando. r,
Fee...` (1.:. Lic.No.� ...... ..... .. ..�.�.........
39 ELECTRICAL INSPECTOR
Check # 1� �
Z — The Commonwealth of Massachusetts Office Use Only
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3 Department of Public Safety Parm't No.--,---
APPLICATION
F ff BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Occupancy 6 Fee Checked
3190 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
MI work to be performed in accordance with the Massachuseds Electrical Code,527 CMR 1200
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date]/Z. d2
City or Town of /Uml l�+G To the Inspector of Wires:
The undersigned applies for a permit to perform the electrical work described below.
Location (Street & Number) S_ 11-/%Z jq AW Roy;f
Owner or Tenant V,,WF_ D 611AU-) f-Sr ZZ
Owner's Address Ii4VY\e--
Is this permit in conjunction with a building permit yes ❑ no 91 (Chi*Appropriate Box)
Purpose of Building >` Utility Authorization No.
Existing Service26� Amps del 4volts Overhead bood:13Jndgrd ❑ No. of Meter
New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters
Number of Feeders and Ampacity
1 Location and Nature of Proposed Electrical Work fca_
TOTAL
No. of lighting Outlets No. of Hot Tubs No. of Transformers KVA
Above In
No. of Lighting Fixtures Swimming Pool grnd.❑ rnd❑ Generators KVA
No. of Emergency Lighting
No.of Receptacle Outlets No. of Oil Burners Battery Units
No.of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones
TOTAL No. of Detection and
No. of Ranges No. of Air Conditioners TONS Initiating Devices
HEAT TOTAL TOTAL No. of Sounding Devices
y No.of Disposals No. of Pumps TONS KW No. of Self Contained
=� Detection/Sounding Devices
No.of DishwashersSpace/Area Heating KW
Municipal
No.
No.of Dryers Heating Devices KW Local E] Connection ❑Other
No. of No. of Low Voltage
No.of Water Heaters KW Signs Ballasts Wiring
No. of Hydro Massae Tubs No. of Motors Total HP
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES NO ❑ I heave submitted
valid proof of same to this office. YES ❑ NO 1.7
If you have checked YES, please indicate the type of coverage by checking the appropriate box. r
INSURANCE BOND ❑ OTHER ❑ (Please Specify)
(Expiration Date)
Estimated Value of Electrical Work S-7� —
Work to Start /d O?i Inspection Date Requested: Rough Final -D Q ajf
Signed under the p aloes o1 perjury:
FIRM NAME ANDREW F SHEEHAN ELECTRICAL CE 4 LIC. NO.All 498
Licensee Andrew F.Sheehan Signature LIC. NO.A11498
Address 249 Pine_ Hill Road/ Chelmsfor,d,Ma_01824 ? Bus. tet. No( 978) 256-8740
All. Tel. No.
OWNER'S INSURANCE WAIVER:I am aware that the Licensee does not have the insurance coverage or its sunstarifial equivalentas required by
Massachusetts General Laws, and that my signature on this application waives this requirement. Owner Agent (Please check one)
Telephone No. PERMIT FEE S 2e
(Signature of Owner or Agent)
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